Lyon-Martin: Back From the Brink

This summer, at Dyke March, Lyon-Martin Clinic was doing what it usually does, which is free clinical breast exams in Dolores Park. “People kept on walking up to us,” says Dawn Harbatkin, the clinic’s executive director, “and saying, ‘I thought you guys closed.’”

They haven’t. And beginning this Thursday, the clinic, whose own board voted to close it down back in January, will begin accepting new patients. The clinic has continued to see its regular clients, but has not been able to take on new ones until now.

The survival of an edgy, innovative clinic like Lyon-Martin, after a combination of diminished funding and billing mismanagement left it in dire financial circumstances, is the story of the kind of grassroots fundraising that is much discussed and aspired to, but not often actually brought to pass.

“I would love it if the thing that saves us was 100,000 people each giving $5,” Dawn Harbatkin, Lyon Martin’s executive director, told Mission Loc@l in an interview eight months ago. “Realistically, it’s going to be mostly a handful of people giving us $50,000 or $100,000.”

Instead, the reverse proved to be true. The clinic did raise the $500,000 it needed to keep its doors open, but most of it was in the form of $5, $10 and $20 increments. “And a lot of that was fundraisers,” says Harbatkin. “It would cost $5 to get in. Someone would hand us $20 and say, ‘Keep the change.’” Aside from a few grants from health-related nonprofits, the largest donation the group received was for $25,000.

Lyon-Martin began in the ’70s as a research project into lesbian health care by a student at the University of California, San Francisco. Since then it has developed specific expertise in health care for transgender people, and in something called “integrated behavioral health,” in which patients with particularly intractable health problems that could be affected by changing their behavior are assigned to a team that consists of one health care provider, one behavioral therapist and one social worker.

It’s an at-times-expensive way to handle health care, says Harbatkin. But it works well, especially with patients who don’t fit the ideal mold of being incredibly excited about taking care of their own health. “If someone is not taking care of their diabetes,” says Harbatkin by way of explanation, “but they’re not taking care of their diabetes because their mom just died, we’re not going to get very far with an ordinary clinic visit.”

It’s often used with patients who have issues with substance abuse. “Meth,” says Harbatkin, “can really get in the way of taking your HIV medicine on time.”

The clinic is not entirely out of the woods yet, in part because of slow reimbursement from some insurers, who typically wait about 20 days before paying a bill. Lyon-Martin is accepting new patients who have MediCal, Medicaid and private insurance, as well as the usual patients who pay what they can out-of-pocket. (Interestingly, the patient that is best for them financially is one that has MediCal, Medicaid or both — because the clinic is a federally qualified health center, it gets more money for its clients who carry public insurance.)

It is not, however, solvent enough to take on patients who have Healthy San Francisco coverage. The rates negotiated with Healthy San Francisco by the Community Clinic Consortium are not payed by the visit. Instead, Healthy San Francisco pays each clinic a one-time fee of $114 for each new member the clinic signs up for the program — an amount that doesn’t even cover the full expense of one office visit, let alone the three per year that is typical for a Lyon-Martin patient. “It’s a great access program,” says Harbatkin. “It just doesn’t cover the cost of care here.”

When the clinic’s imminent closure was first announced, Lyon-Martin was overwhelmed not only with support, but with well-intended fundraising ideas. Among them: Support your clientele by becoming a pot club (interesting, says Harbatkin, but not especially easy to do). A more likely long-term plan is collaborating with other organizations on medical research projects. Instead, the clinic has settled down to funding stream of events, dinner parties and social networking-based fundraisers like 30 Days of Health, where people sign up to do everything from swinging clubs in the air for 30 minutes a day to quitting smoking.

“I really empathize with the people who are trying to quit smoking,” says Harbatkin, slipping into integrated behavioral health mode. “When you do that, you really need to replace an unhealthy habit with a healthy one. Like running. Or chewing straws. That also helps.”

Lyon-Martin celebrates its reopening to new patients this Thursday, from noon to 1 p.m., with a ribbon-cutting ceremony and a possible visit from the Sisters of Perpetual Indulgence.